
<!DOCTYPE html>
<html>
<head lang="en">
    <meta charset="UTF-8">
    <meta name="viewport" content="width=device-width, initial-scale=1, maximum-scale=1, user-scalable=no">
    <title>银联回呼充值</title>
    <link rel="stylesheet" href="../css/wzl-bootstrap.css?q=1111"/>
    <link rel="icon" href="../favicon.ico" type="image/x-icon" />
    <link rel="shortcut icon" href="../favicon.ico" type="image/x-icon" />
    <script src="../js/dist/seajs/2.3.0/dist/sea.js"></script>
    <script>
        seajs.config({
            base:'../js/dist'
        })

        seajs.use('wzlh5/1.0.0/user',function(register){
            register.register();
        })
    </script>
    <!-- 行内样式属于该页面独有样式 -->
    <style>
        /* 重新定制 ul样式 */
        .list-group{
            background: #fff;
            border-radius: 5px;
            border: 1px solid #dddddd;
        }
        .list-group-item{
            position: relative;
            display: block;
            margin: 0 0px;
            padding:8px 10px;
            background-color: #ffffff;
            border-top:none;
            border-left:none;
            border-right:none;
            border-bottom: 1px solid #f3f3f3;
        }
        /* 重新定制 form-control */
        .form-control{
            padding:6px 6px 6px 0;
        }

        .wzl-form-control{
            padding: 0 10px;
            margin-bottom: 20px;
        }
        .wzl-form-control-list{
            margin-top: 6px;
        }

        .mr5{margin-right: 5px;}

    </style>
</head>
<body>
<div id="warp">
    <div class="top-buff-bar"></div>
    <nav class="wzl-navbar navbar-default" role="navigation">
        <div class="container-fluid">
            <div class="navbar-header">
                <div class="wzl-nav-bar">
                    <span class="glyphicon glyphicon-wzl-back" onclick="history.back(-1)"></span>银联回呼充值
                </div>
            </div>
        </div>
    </nav>

    <div class="wzl-form-control">
        <select class="form-control pl10">
            <option>选择银行</option>
            <option>2</option>
            <option>3</option>
            <option>4</option>
            <option>5</option>
        </select>
    </div>

    <div class="wzl-form-control clearfix">
        <div class="pull-left wzl-form-control-list pl10">
            <span>银行所在地：</span>
        </div>

        <div class="pull-right ml20 ">
            <select class="form-control pl10">
                <option>选择省</option>
                <option>2</option>
                <option>3</option>
                <option>4</option>
                <option>5</option>
            </select>
        </div>

        <div class="pull-right ml20 pl10">
            <select class="form-control">
                <option>选择市</option>
                <option>2</option>
                <option>3</option>
                <option>4</option>
                <option>5</option>
            </select>
        </div>

    </div>

    <div class="container">
        <form action="" role="form" class="">
            <ul class="list-group mb60" >
                <li class="list-group-item ">
                    <input type="text" class="form-control" name="username" value="" placeholder="银行卡号（必填）"/>
                </li>
                <li class="list-group-item clearfix">
                    <span class="form-control">*宏招</span>
                </li>
                <li class="list-group-item clearfix wzl-verifycode-block">
                    <span class="form-control">11111111111111111111</span>
                </li>
                <li class="list-group-item clearfix wzl-verifycode-block">
                    <div class="pull-left">
                        <input type="password" class="form-control wzl-verify-input"placeholder="我中啦密码（必填）"/>
                    </div>
                </li>
            </ul>
        </form>

        <a href="javascript:;" class="btn btn-wzl-default btn-lg btn-block wzl-mb-20"> 提交绑定</a>

        <div class="form-group wzl-mb-40">
            <p class="text-muted"> <span class="wzl-text-warning">温馨提示: </span><br>支付宝开户信息必须与您在网站实名认证的信息一致，不一致将无法使用支付宝提现。如需更改支付宝信息，请拨打客服电话：4006865015
            </p>
        </div>
    </div>
</div>

<div class="wzl-mask">
    <div class="wzl-service">
        <div class="head">
            <h4>选择银行</h4>
            <span class="glyphicon icon-close" onclick="document.querySelector('.wzl-service').style.display='none'"></span>
        </div>
        <div class="content">
            <div class="wzl-form-control">
                <select class="form-control pl10">
                    <option>选择银行</option>
                    <option>2</option>
                    <option>3</option>
                    <option>4</option>
                    <option>5</option>
                </select>
            </div>

            <div class="wzl-form-control clearfix">
                <div class="pull-left wzl-form-control-list pl10">
                    <span>银行所在地：</span>
                </div>

                <div class="pull-right ">
                    <select class="form-control mr5">
                        <option>选择省</option>
                        <option>2</option>
                        <option>3</option>
                        <option>4</option>
                        <option>5</option>
                    </select>
                </div>

                <div class="pull-right mr5">
                    <select class="form-control">
                        <option>选择市</option>
                        <option>2</option>
                        <option>3</option>
                        <option>4</option>
                        <option>5</option>
                    </select>
                </div>

            </div>

            <div class="container">
                <form action="" role="form" class="">
                    <ul class="list-group mb60" >
                        <li class="list-group-item ">
                            <input type="text" class="form-control" name="username" value="" placeholder="银行卡号（必填）"/>
                        </li>
                        <li class="list-group-item clearfix">
                            <span class="form-control">*宏招</span>
                        </li>
                        <li class="list-group-item clearfix wzl-verifycode-block">
                            <span class="form-control">11111111111111111111</span>
                        </li>
                        <li class="list-group-item clearfix wzl-verifycode-block">
                            <div class="pull-left">
                                <input type="password" class="form-control wzl-verify-input"placeholder="我中啦密码（必填）"/>
                            </div>
                        </li>
                    </ul>
                </form>

                <a href="javascript:;" class="btn btn-wzl-default btn-lg btn-block wzl-mb-20"> 提交绑定</a>

                <div class="form-group wzl-mb-40">
                    <p class="text-muted"> <span class="wzl-text-warning">温馨提示: </span><br>银行开户人必须和您在网站认证的姓名和证件号码一致。
                    </p>
                </div>
            </div>

        </div>
    </div>
</div>

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</body>
</html>